A New Patient Acuity Tool to Support Equitable Patient Assignments in a Progressive Care Unit.

Making fair and equitable staffing decisions and patient assignments created complexities and undue nursing dissatisfaction on a 20-bed progressive care unit. Common themes shared by the nursing staff included inadequate staffing ratios, increased workload, and unease for patient safety. On the basis of these concerns, a unit-based needs assessment provided insight into what perceived and actual barriers exist preventing nurses from providing excellent care. Information gathered helped determine what could be done to overcome some barriers, and performing a comprehensive unit profile assessment allowed for better insight into how the unit was currently functioning. A comprehensive review of literature was undertaken to examine articles related to patient acuity utilizing the electronic databases CINAHL, PubMed, and MEDLINE. Key words and phrases included the following: acuity, patient acuity, acuity tools, progressive care acuity, nurse-patient assignment, workload, nursing assignments, and equitable staffing. Utilizing the results of the nurse survey, and information gained from articles gathered during the literature review, a patient acuity tool was created. The tool was believed to be an accurate representation of the patients' acuity, and the majority of charge nurses reported that they utilized the patient acuity tool score when making nurse-patient assignments. Overall staff satisfaction and perceptions of nurse-patient assignment equity were improved.

Managing Falls: Implementation of a Three-Intervention Initiative to Improve Quality of Care for Patients With Cancer.

BACKGROUND: All healthcare institutions prioritize falls as a major safety issue. Falls are of particular concern on inpatient oncology units where patients are substantially at risk for injury related to falls. OBJECTIVES: This article describes a multifaceted fall-prevention initiative that can be implemented on oncology units using evidence-based interventions in the key areas of communication, toileting, and hourly rounding. The Visual Rounding Tool for communication around hourly rounding and proactive toileting is also introduced. METHODS: Based on a root cause analysis and literature review, the inpatient oncology unit-based committee launched a three-intervention initiative, carried out during three consecutive months, to address patient falls. FINDINGS: Fall rates decreased using the three- intervention initiative. Systematic improvement in processes enabled an increased occurrence of communication between nurses and assistive personnel, increased use of the Visual Rounding Tool for proactive toileting and hourly rounding, and a significant but short-lived decrease in call light use.

The Trach Trail: A Systems-Based Pathway to Improve Quality of Tracheostomy Care and Interdisciplinary Collaboration.

OBJECTIVE: To implement a standardized tracheostomy pathway that reduces length of stay through tracheostomy education, coordinated care protocols, and tracking patient outcomes. METHODS: The project design involved retrospective analysis of a baseline state, followed by a multimodal intervention (Trach Trail) and prospective comparison against synchronous controls. Patients undergoing tracheostomy from 2015 to 2016 (n = 60) were analyzed for demographics and outcomes. Trach Trail, a standardized care pathway, was developed with the Iowa Model of Evidence-Based Practice. Trach Trail implementation entailed monthly tracheostomy champion training at 8-hour duration and staff nurse didactics, written materials, and experiential learning. Trach Trail enrollment occurred from 2018 to 2019. Data on demographics, length of stay, and care outcomes were collected from patients in the Trach Trail group (n = 21) and a synchronous tracheostomy control group (n = 117). RESULTS: Fifty-five nurses completed Trach Trail training, providing care for 21 patients placed on the Trach Trail and for synchronous control patients with tracheostomy who received routine tracheostomy care. Patients on the Trach Trail and controls had similar demographic characteristics, diagnoses, and indications for tracheostomy. In the Trach Trail group, intensive care unit length of stay was significantly reduced as compared with the control group, decreasing from a mean 21 days to 10 (P < .05). The incidence of adverse events was unchanged. DISCUSSION: Introduction of the Trach Trail was associated with a reduction in length of stay in the intensive care unit. Realizing broader patient-centered improvement likely requires engaging respiratory therapists, speech language pathologists, and social workers to maximize patient/caregiver engagement. IMPLICATIONS FOR PRACTICE: Standardized tracheostomy care with interdisciplinary collaboration may reduce length of stay and improve patient outcomes.